Q. I have a double chin that I have had since I was in college.  It is worse now because I have gained some weight and I am older.  What are the options for correcting my double chin?

A. Typically, a double chin starts out when we are young with just some excess fat underneath the chin.  As we age, the fat may increase a little, giving more fullness under the chin.  Additionally, as we age the quality of the neck and chin skin deteriorates which creates sagginess of the skin.  The key to improving the shape of your neck is to first determine if your problem is a fat issue alone, or a combination of both excess fat and loose skin.  If you are relatively young, (say 40 or so), the quality of chin and neck skin is typically good enough to allow just fat removal, without the need for skin tightening.  So if this describes your situation, the two options for fat removal are liposuction or Coolsculpting. 

Liposuction requires surgery, anesthesia, and a very small incision in order to remove the fat.  It typically will contour the neck better than Coolsculpting, but surgery does have the disadvantage of some downtime (about a week) and having to wear a compression garment around the neck for about 2 weeks. There is minimal pain associated with liposuction, but there can be some persistent swelling, so it can take several months before you will see the final results.  Liposuction is only indicated when there is little or no skin laxity in the chin and neck area. 

Coolsculpting, a non-invasive option for fat removal, does not require surgery and there is no downtime or garments to wear.  Coolsculpting works by freezing the fat under the chin, after which about 22% of the fat will die, then be metabolized and removed from the body naturally.  It can take one or two treatments to remove enough fat to deliver the results most people are looking for. Coolsculpting of the chin area takes about an hour to perform.  The final results of the treatment usually take about 3 months before all the fat has been naturally removed from the area. A word of caution, just as in liposuction, if there is loose skin under the chin, then Coolsculpting is probably not the right answer for you. 

If a patient has both loose skin and fat under the chin, a combination of liposuction for the removal of the fat and a neck lift for tightening of the skin will be a better option.  Obviously, a neck lift in combination with liposuction is a more aggressive approach, but this procedure will reshape and rejuvenate the neck better than liposuction or Coolsculpting alone.  It should be mentioned that it is very rare that a neck lift alone is performed as an isolated procedure, since it is common that when someone has loose neck skin, there is often laxity of the cheek skin as well.  As a result, most patients requiring a neck lift also benefit by having a face lift at the same time. Tightening the neck and not correcting cheek laxity creates disharmony between a rejuvenated neck and uncorrected aging face.  I would recommend a consult with a board certified plastic surgeon to get a customized evaluation of your chin.